Takeshi Nishi1, Noritaka Ariyoshi2, Takashi Nakayama3, Yoshihide Fujimoto3, Kazumasa Sugimoto3, Shinichi Wakabayashi3, Hideki Hanaoka4, Yoshio Kobayashi3. 1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: takeshi24@hotmail.co.jp. 2. Division of Pharmacy, University Hospital, Chiba University School of Medicine, Chiba, Japan; Clinical Research Center, University Hospital, Chiba University School of Medicine, Chiba, Japan. 3. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 4. Clinical Research Center, University Hospital, Chiba University School of Medicine, Chiba, Japan.
Abstract
BACKGROUND: The impact of chronic kidney disease (CKD) on the antiplatelet effect of clopidogrel and low-dose (3.75mg) prasugrel in Japanese patients is largely unknown. METHODS: A total of 53 consecutive Japanese patients with stable coronary artery disease who received aspirin and clopidogrel were enrolled, and categorized by estimated glomerular filtration rate (eGFR): CKD group (n=15, eGFR<60ml/min/1.73m2) and non-CKD group (n=38, eGFR≥60ml/min/1.73m2). Clopidogrel was switched to 3.75mg prasugrel. Platelet reactivity measurement using the VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA) was performed at baseline (on clopidogrel) and day 14 (on prasugrel). RESULTS: The VerifyNow P2Y12 reaction units (PRU) during clopidogrel therapy was significantly higher in the CKD group than that in the non-CKD group (185.2±51.1 PRU vs. 224.3±57.0 PRU, p=0.02), whereas, the PRU with the prasugrel therapy in the CKD group and non-CKD group were not significantly different (149.9±51.1 PRU vs. 165.3±61.8 PRU, p=0.36). The PRU was significantly lower with the prasugrel therapy compared to that with the clopidogrel therapy both in the CKD group and in the non-CKD group. CONCLUSIONS: Antiplatelet effect of clopidogrel but not prasugrel is attenuated in patients with CKD. Prasugrel achieves a consistently lower platelet reactivity compared with clopidogrel regardless of the presence of mild to moderate CKD.
BACKGROUND: The impact of chronic kidney disease (CKD) on the antiplatelet effect of clopidogrel and low-dose (3.75mg) prasugrel in Japanese patients is largely unknown. METHODS: A total of 53 consecutive Japanese patients with stable coronary artery disease who received aspirin and clopidogrel were enrolled, and categorized by estimated glomerular filtration rate (eGFR): CKD group (n=15, eGFR<60ml/min/1.73m2) and non-CKD group (n=38, eGFR≥60ml/min/1.73m2). Clopidogrel was switched to 3.75mg prasugrel. Platelet reactivity measurement using the VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA) was performed at baseline (on clopidogrel) and day 14 (on prasugrel). RESULTS: The VerifyNow P2Y12 reaction units (PRU) during clopidogrel therapy was significantly higher in the CKD group than that in the non-CKD group (185.2±51.1 PRU vs. 224.3±57.0 PRU, p=0.02), whereas, the PRU with the prasugrel therapy in the CKD group and non-CKD group were not significantly different (149.9±51.1 PRU vs. 165.3±61.8 PRU, p=0.36). The PRU was significantly lower with the prasugrel therapy compared to that with the clopidogrel therapy both in the CKD group and in the non-CKD group. CONCLUSIONS: Antiplatelet effect of clopidogrel but not prasugrel is attenuated in patients with CKD. Prasugrel achieves a consistently lower platelet reactivity compared with clopidogrel regardless of the presence of mild to moderate CKD.
Authors: Alessandro Caracciolo; Renato Francesco Maria Scalise; Fabrizio Ceresa; Gianluca Bagnato; Antonio Giovanni Versace; Roberto Licordari; Silvia Perfetti; Francesca Lofrumento; Natasha Irrera; Domenico Santoro; Francesco Patanè; Gianluca Di Bella; Francesco Costa; Antonio Micari Journal: J Clin Med Date: 2022-04-23 Impact factor: 4.964
Authors: Jae Min Kim; Jin Sug Kim; Hyung Oh Kim; So Ra Lee; Jae Hwan Rhew; Jong Shin Woo; Jang Hyun Cho; Kyung Hwan Jeong; Weon Kim Journal: Medicine (Baltimore) Date: 2020-03 Impact factor: 1.817